Addendum to Supporting Statement

Addendum 0323.doc

Third Party Liability Information Statement

Addendum to Supporting Statement

OMB: 0960-0323

Document [doc]
Download: doc | pdf

Addendum to Supporting Statement for Form SSA-8019-U2

Third Party Liability Information Statement

42 CFR 433.136-433.139

OMB No. 0960-0323




Minor Revisions to the Collection Instrument


SSA is making the following revisions:


  • Change #1: We are revising the Privacy Act Statement on this form.


Justification #1: SSA’s Office of the General Counsel is conducting a systematic review of SSA’s Privacy Act Statements on agency forms. As a result, SSA is updating the Privacy Act Statement on the form.

File Typeapplication/msword
File TitleAddendum to the Supporting Statement for Form SSA-3462
Author177717
Last Modified BySYSTEM
File Modified2018-04-10
File Created2018-04-10

© 2024 OMB.report | Privacy Policy